title: Adolescents with suicidal ideation: health care use and functioning.
abstract: OBJECTIVE
  To improve our understanding of the clinical needs among youth with suicidal ideation (SI), we examined health care utilization patterns, functional impairment, and comorbidity among youth who endorsed SI, compared with a control group of youth without SI.
  
  
  METHODS
  This study included 99 youth with SI in the past year and 99 matched controls. Participants were 13- to 17-year-old youth who were enrolled in a large integrated care delivery system who had seen a provider at least one time in the past year. The 2 groups were compared with regard to health care utilization, functional impairment, and comorbid mental health symptoms, while adjusting for depression severity, lifetime diagnosis of depression or anxiety, and medical comorbidity.
  
  
  RESULTS
  Youth with SI had a significantly higher mean functional impairment compared with youth without SI, both at baseline (84% vs 60% "definitely impaired") and 6-month follow-up (57% vs 39% "definitely impaired"). Less than 15% in either group attended a mental health specialty visit in the 12 months before or after baseline, and under 10% received antidepressant or anxiolytic medication. Family-report data suggested that a higher proportion of youth with SI received mental health care from sources outside their health care system compared with youth without SI.
  
  
  CONCLUSIONS
  The presence of SI is associated with more severe functional impairment, comorbidity, and depression severity. Yet, only a minority of adolescents with SI receive mental health services, and clinical detection is low. This study suggests that better screening, recognition, and treatment of SI is needed to address the clinical impairment of youth with SI.
authors.affiliation: Department of Pediatrics, School of Medicine, University of Washington, Seattle 98145, USA. cmccarty@u.washington.edu
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: McCarty
authors.forename: Joan
authors.initials: J
authors.lastname: Russo
authors.forename: David C
authors.initials: DC
authors.lastname: Grossman
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
authors.forename: Carol
authors.initials: C
authors.lastname: Rockhill
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McCauley
authors.forename: Julie
authors.initials: J
authors.lastname: Richards
authors.forename: Laura
authors.initials: L
authors.lastname: Richardson
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D059020:Suicidal Ideation